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32C-082 (3) CUSTOMER CONTRACT 1 Hartford Square Suite 16-206 New Britain,CT 06052 877.306.4483 Office a 8603575691 Fax HIC#167827 info@victoryenergysolutions.com IC`To�H' >,�rrt�c'Y"'I.i'TIi►Nri R 'RIOW Representive: Elizabeth George 24 Wilson Ave Northampton,MA 01060-3814 Site ID:500050074273 Project ID:P00050085241 Customer ID:C00050074808 Contract ID:20150810 ASEAL Description Quantity Location Perform Air Sealing at Estimated 82.5 CFM50 Per Hour 4 Living Space $337.28 Door Sweep 1 N/A $2318 Exterior Door Weather Stripping 3 N/A $82.77 Sub Total: $443.23 Utility Incentive Share $443.23 Customer Contribution $0.00 TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor agrees to perform the above described work,furnishing om dal and labor spedified above for the total price fisted above. Payment of the full amount of Total is expected by pf contradepdag work.Zf paying by credit card a 3%service charge will be added.Deposit may not exceed one-thi nce- Deposit Amount Deposit Date Final Balance Balance Due Upon Completion of Work Scope TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor agrees to perform the above described work,furnishing the material and labor specified above for the total price listed above. Payment of the full amount ofTotal is expected by cash or check upon completion of contracted work. If paying by credit card a 3%service charge will be added. The customer agrees to pay the balance of the cost above upon completion of the job. Do NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Customer Signature:_ Date Contractor Signature / Date LIMITED TIME OFFER:The prick and'M s o er m -ro change in accordance with the CSG Mass Save Home energy Services Program offers. Terms and conditions on reverse CUSTOMER CONTRACT I Hartford Square Suite 16-206 New Britain,Cr 06052 877.306.4483 Office 8603575691 Fax HIC#167827 PARTICM116 info@victoryenergysolutions.com CON"Um Representive: Elizabeth George 26 Wilson Ave Fl 2 Northampton,MA 0 1 060-38 14 Site TD;S00050071726 Project ID:P00050082331 Customer ID:C00050072233 Contract fl).20150810ASEAL Description Quantity Location Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 2 Living Space $168.64 Door Sweep 2 N/A $46.36 Exterior Door Weather Stripping —3 N/A $82.77 Sub Total: $297.77 Utility Incentive Share $297.77 Customer Contribution $0.00 TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor agrees to perform the above described work furnishing the material and labor spedfied above for the total price rated above. Payment of the full amount of Total is expected by cash or check u W.i f'contras V16 r&2" paying by credit card a 3%service charge will be added.Deposit may not exceed one-ith 2tmw ft' nCe. Deposit Amount Deposit Date Final Balance Balance Due Upon Completion of Work Scope TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor agrees to perform the above described work.furnishing the material and labor specified above for the total price listed above. Payment of the full amount of Total is expected by cash or check upon completion of contracted work. If paying by credit card a 3%service charge will be added. The customer agrees to pay the balance of the cost above upon completion of the job. 00 NOT SIGN CT IF THERE ARE ANY BLANK SPACES Customer Signature-. Date Contractor Signatur Date—J LIMITED TIME OFFER The pnand incentives offered in this o ract are subject to change in accordance with the CSG Mass Save Home energy rvices Program offers. Terms and conditions on reverse CUSTOMER CONTRACT 1 Hartford Square =""'New Britain,R 2 877306.4483 Office 8603575691 Fax HIC#167827 114 TORV� 6 info@victoryenergysolutions.com - - 'quaw Representive: Elizabeth George 24 Wilson Ave Northampton,MA 01060-3814 Site ID:SOOOSM4273 Project ID:P00050085241 Customer ID:C00050074808 Contract ID:20150810 WORK Description Quantity Location Insulate Rim Joist with 6.25'Fiberglass Batting 128 Living Space $307.20 Insulation Removal 128 N/A $147.20 Sub Total: $454.40 Utility Incentive Share $230.40 Customer Contribution $224.00 Pre Weatherization Incentive $250.00 Remaining Customer Contribution $0.00 Incentive Balance Due to Customer $26.00 TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor agrees to perform the above described work,furnishing the material and labor specified above for the total price listed above. Payment of the full amount ofTotal is expected by cash or chedc u of contracted work If Paying by credit card a 3%service charge will be added.Deposit may not exceed one�h Page 2 of 2 Deposit Amount Deposit Date Final Balance Balance Due Upon Completion of Work Scope TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor agrees to perform the above described work,furnishing the material and labor specified above for the total price listed above. Payment of the full amount of?otal is expected by cash or check upon completion of contracted work. If paying by credit card a 3%service charge will be added. The customer agrees to pay the balance of the cost above upon completion of the job. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Customer Signature:_ _Date Contractor Signature:_ Date LIMITED TIME OFFER:The prices and incentives o ered in this Contract are subject to change in accordance with the CSG Mass Save Home energy Services Program offers. Terms and conditions on reverse The Commonwealth of Massachusetts = Department of Industrial Accidents d 1 Congress Street,Suite 100 Boston,MA 02114-2017 M www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. ApWicant Information Please Print Le ibl Name (Business/Organization/Individual): Address: 1( or 8 City/State/Zip: ` Yl Phone #: �'�- ZL ON(0 - q y OFQ re you an employer?Check the appropriate box: Type of project(required): I. I am a employer with,30 employees(full and/or part-time).* 7. E]New construction 2.a I am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.[J I am a homeowner doing all work myself.[No workers'comp. insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.[:]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ p ROof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14 Other SL�CL� Ln1`'i' 152,§1(4),and we have no employees. [No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name::Z-s-n T,05L)-r �_"go, gg 8 Policy#or Self-ins. Lic.#: Q I A w, 45 Expiration Date: 4 Job Site Address: ' 2.(0 wil5on Ave- City/State/Zip: ISOr+hannpA-et-, MA Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi nder the pains penalties ofperjury that the information provided above is true and correct. S i Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Pbone#: SECTION 8-CONSTRUCTION SERVICES 7 8.1 Licensed Construction Supervisor: � Not Applicable ❑ Name of License Holder:. 1 i L h Q e-1 (V 1 jo n E r' 1 c O © CS- 10%2-1 Z License Number ` oLt-12 (0 IZ0 )1 15 nis�eht� Avenge , ��+er�"aVVn � M i4 Address / Expiration Date T11 -ZNP- Li433 sig"dit"641, Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ V� L r�� E1-�er si Sc1La-hons 16106 2--7 Company Name Registration Number One HwrfFibrd 1115111, Address Expiration e gr'1-1 CLI'n CT 0005'2 Telephone'&1-11- 3C 1a -�1�g7a SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... V No...... ❑ 11. Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature 5 e ck-�ko(_J e 51 qn ed Cbn+r G Gt, SECTION 5-DESCRIPTION OF PROPOSED WORK(check all agglicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[0] Other[0] Brief Description of Proposed Work: Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes `� No Attached Narrative Renovating unfinished basement Yes ✓No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, E It Z o0b e+In C e-c Y—!; as Owner of the subject property -1 t hereby authorize M +G h o►� ( i o n F r i g p o to act on my behalf, in all matters relatives to work authorized by this building permit applic tion. Signature,eflOwner _ Date I, %C`n q e-l G t O n F r t d(AO as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. 1 Ito n (�- , d d Print Name --- cq III i 5 Signature of er/Agent Da � \ . � �\ . � � f� : \ � \ .\ � � $ ^ � . /� . : .�.,� ƒ | ■�� � : \ J % + \ � � / � k % � . � . Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Front Setba s Front e L: R: L: R: Rea Buit ng Height Bl . Square Footage Open Space Footage /o (Lot area minus bldg&paved - parking) #of Parking Spaces Fill: volume&Location A. Has a Sp al Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the ermit recorded at the Registry of Deeds? NO DON'T KNOW ® YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained ® , Date Issued: C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,excayXion, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. CSC., X55°° Department use only r City of Northampton Status of Permit: i � iiding Department Curb Cut/Driveway Permit YIL S�P 212 Main Street Sewer/Septic Availability E(j� I /I Room 100 WaterNVell Availability " 1 rthampton, MA 01060 Two Sets of Structural Plans Electric,o &G, 41 -587-1240 Fax 413-587-1272 Plot/Site Plans rtha Pion, �q 01060eciions Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: Z� 2-f0 Ww 15c r% Avenu a Map Lot Unit N o r+t-,a,m pi-o h p Ma, 0'011,00 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: �- E\17-0. et ry 2q/2-6 wilson A,venue"' 2ND * 3rd Floors Name(Print) Current Mailing Address: 1 4r3-- 531 - 2-4P 5q 5�r✓ clttache S1fahL'4k Con}r�G+l Telephone Signature 2.2 Authorized Anent: M%C\na 1 GrQnFr Iddo 15 N,c-ch►S Ave - Ali water+0W% M�4 Name(Print) Current Mailing Address: 02-4-11— J44 93 Signat Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com feted by ermit applicant 1. Building ('v (a) Building Permit Fee ZIC�°I 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection e� 6. Total=0 +2+3+4+5) 21 Oct .(at Check Number This Section For Official Use Only Building ermit Number: Date g Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2016-0378 APPLICANT/CONTACT PERSON VICTORY ENERGY SOLUTIONS LLC ADDRESS/PHONE 1 HARTFORD SQ SUITE 206 NEW BRITAIN06052(877)306-4483 Q PROPERTY LOCATION 24 WILSON AVE MAP 32C PARCEL 082 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid ,527 SdE Building Permit Filled out Fee Paid Typeof Construction: INSTALL ATTIC INSULATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 108212 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: //Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management e DI r of it i f al Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. 24 WILSON AVE BP-2016-0378 G1S#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C-082 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Categorv: INSULATION BUILDING PERMIT Permit# BP-2016-0378 Project# JS-2016-000615 Est.Cost:$2110.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: VICTORY ENERGY SOLUTIONS LLC 108212 Lot Size(sq. 1): 5096.52 Owner: GEORGE ELIZABETH M Zoning: URC(l00)/ Applicant: VICTORY ENERGY SOLUTIONS LLC AT.• 24 WILSON AVE Applicant Address: Phone: Insurance: 1 HARTFORD SQ SUITE 206 (877) 306-4483 O WC NEW BRITAINCT06052 ISSUED ON.912312015 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL ATTIC INSULATION POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 9/23/2015 0:00:00 $55.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner